Health IT is "health information technology" - the use of computers and computer programs to store, protect, retrieve, and transfer clinical, administrative, and financial information electronically within health care settings. Key elements of health IT include:
Electronic health records for patients, in place of paper records.
Secure electronic networks to deliver up-to-date records whenever and wherever the patient or clinician may need them.
Electronic transmittal of medical test results to speed and streamline processing of those results by health care providers.
Confidential access for consumers to their own personal health information online, as well as reliable web-based health information for consumers.
Electronic - and more efficient - communication between patients and health care providers, and among different providers.
Electronic prescribing of medications, treatments, and tests, to help avoid medical errors.
Decision support systems to provide clinicians with up-to-the-minute information on best practices and treatment options.
Electronic devices like handheld computers to make information available at the point of care.
What are the benefits of an electronic health record?
The electronic health record (EHR) can make complete medical information about a patient available to the clinician at the point of care, without the patient having to fill out unnecessary forms or remember the details of his or her medical history. Typically, the EHR would include information on the patient's medication and immunization history, laboratory results, radiographs, family history, and other medical history.
The EHR will play a key role in improving care for people with chronic conditions, such as diabetes or asthma, who frequently see multiple providers, including specialists. An EHR would make important information about patients available to all their clinicians, so that clinicians can coordinate care without duplicative or conflicting actions.
Ultimately, the EHR will allow clinicians to spend more time caring for their patients, instead of conducting lengthy and sometimes frustrating searches for the information they need to provide good care. And, in a fully networked system, a patient's record would be immediately available in an emergency, no matter where the emergency occurs.
As the lead research agency on the quality, safety, efficiency, and effectiveness of health care in the U.S., AHRQ plays a key role in the nation's efforts to adopt health IT. First, AHRQ helped lay the groundwork for health IT today, through more than 30 years of research to develop medical informatics tools and standards. In addition, AHRQ has helped identify critical patient safety issues and demonstrate the importance of decision support systems for physicians and others in a time of rapidly growing medical findings. In 2002, AHRQ began planning its current health IT initiative, aimed at supporting communities and regions as they plan and implement health IT projects. With a new multi-year, $166 million initiative, AHRQ moved beyond basic research to fund projects that demonstrate and evaluate health IT use for a variety of health care purposes. A major priority is to disseminate new knowledge and best practices from pioneers in this field, so that future users can benefit from their experiences and lessons learned.
AHRQ's health IT initiative includes a broad scope of activities to promote, implement, and measure the value of health IT; develop statewide and regional networks; and encourage adoption of health IT by sharing knowledge. With grants and contracts in 41 states, AHRQ is stimulating investment in health IT across the nation, especially in rural and underserved areas. The initiative has three basic components:
In September 2004, AHRQ announced more than 100 grants to communities, hospitals, providers, and health care systems nationwide to support the development and use of health IT. These grants include a special focus on small and rural hospitals and communities. First-year funding is $41 million, and total funding over three years will amount to nearly $96 million.
At the same time, AHRQ awarded five-year contracts to Colorado, Indiana, Rhode Island, Tennessee, and Utah to develop statewide networks that make health information more available to health care providers while maintaining the security and privacy of health information. Participants include major purchasers of health care, public and private payers, hospitals, ambulatory care facilities, home health care providers and long-term care providers. First-year funding is $1 million for each state and will total $25 million over the course of the contracts.
Finally, AHRQ awarded a two-year contract, renewable for up to three years, to NORC, a national organization for research at the University of Chicago, to create the AHRQ National Resource Center for Health Information Technology. First-year funding is $4 million, with an estimated value of $18.5 million over the course of the contract.
What areas of health IT are being studied under the AHRQ initiative?
AHRQ's health IT initiative funds more than 100 projects that cover a wide range of issues, including the following:
Examination of health IT effectiveness in various types of information exchange, including medical referrals, transferring radiology and other test results, and information sharing among care teams.
Impact of e-prescribing for different age groups and different medical conditions.
Use of health IT systems for patient safety improvement, providing for "blame-free" reporting of adverse events and close calls.
Impact of health IT on clinician workflow.
Health IT applications for chronic diseases, especially diabetes and asthma.
Demonstration of a patient-centered wellness application.
Effectiveness of health IT in the emergency setting.
Health IT use in nursing homes, including the impact of clinical decision support.
Effectiveness of various applications of telemedicine, including distance management of cancer and chronic conditions.
Assessing incremental introduction of health IT capabilities.
Effectiveness of health IT in monitoring the quality of care delivered in specific types of facilities.
Health IT applications that provide clinical decision support.
Impact of sharing access to electronic medical records with patients.
Impact of health IT on the continuum of care for patients as they are discharged from intensive care and when they return to the community.
Use of health IT systems in creating an evidence base for treatment of particular conditions.
When will AHRQ's health IT grants and contracts share their research findings?
Most of AHRQ's health IT grants are three-year projects, and the five contracts for statewide systems are five-year projects. These grants and contracts were awarded in the fall of 2004. However, AHRQ will not wait to begin collecting and releasing observations from these projects. Information and interim findings garnered from the projects, as well as from other AHRQ activities, will be shared as quickly as possible through the National Resource Center. Rapid dissemination and availability of useful information generated by the health IT initiative is a top priority for AHRQ.
What is the function of the AHRQ National Resource Center for Health Information Technology?
AHRQ established the National Resource Center for Health Information Technology to encourage adoption of health IT by sharing the findings and lessons from the real-world laboratory created in AHRQ's health IT initiative. By disseminating new knowledge, providing technical assistance, and serving as a repository for best practices, the National Resource Center can help providers explore the adoption and use of health IT to improve patient safety and quality of care.
The National Resource Center will also provide experience-based information about planning and implementing health IT projects, and about the value added by health IT capabilities. Providers who want to implement health IT can learn practical solutions for overcoming barriers, including lessons from the experiences of small medical practices and hospitals, as well as long-term care facilities and home health agencies. The National Resource Center will also serve as a sounding board for grantees and others to share their experiences.
AHRQ works with other federal agencies, notably the Centers for Medicare & Medicaid Services (CMS). AHRQ serves as CMS' "science partner" in evaluating its demonstration projects involving health IT, especially the Doctors Office Quality - Information Technology (DOQ-IT) project, which supports implementation of health IT systems in small practices. AHRQ also supports the development of standard clinical terminology for health IT applications, working with the National Library of Medicine. Other AHRQ-supported activities include:
Surveys to measure the penetration of health IT in small medical practices.
Development of information that strengthens the business case for investment in health IT.
Certification of health IT products to help providers know the products they purchase are of high quality and consistent with long-range plans for interconnectivity.
Agreement on standards for content and format of electronic health records. Recently, AHRQ has turned new attention to securing trust in electronic health information systems, exploring a variety of legal issues ranging from privacy concerns to error reporting. The goal is to accelerate the resolution of key legal issues and disseminate usable guidance.
Finally, AHRQ also supports a body of research geared at improving patient safety and reducing medical errors through its Patient Safety Research Coordinating Center. Many of the grants in this research portfolio include a strong health IT component. The work of the Patient Safety Research Coordinating Center is coordinated with that of the AHRQ National Resource Center for Health Information Technology.
How has AHRQ's research helped prepare for the health IT transformation?
AHRQ and its predecessor agencies have supported research in health informatics for 35 years. This work has helped develop data tools and languages for use in health care settings, and has pointed to the need for health IT. AHRQ-supported research demonstrated the importance of decision support for physicians and others in a time of rapidly growing medical findings and options. AHRQ-supported research also figured prominently in drawing attention to the high number of deaths and injuries to patients caused by medical errors - and in developing a response to help improve patient safety.
At the same time, AHRQ has led the nation in assembling the large cooperative data sets that have expanded our understanding of health care utilization in the United States. Finally, AHRQ has helped spearhead the development of evidence-based practice, the movement to determine scientifically and rigorously which treatments are most effective for which conditions. Evidence-based guidance and options can help clinicians provide effective and high-quality care, and health IT can help make such information available at the point of care.
In addition to stimulating the growth of health IT, the initiative is designed to elicit the greatest possible amount of information about real-world experience with health IT. This information will help providers who are considering investing in health IT, as well as policymakers seeking to encourage health IT investment.
AHRQ will also be a trusted source of information and technical assistance for health care providers as they launch and use health IT systems. The projects funded by AHRQ's initiative constitute a real-world laboratory for examining health IT at work. They cover a variety of health IT applications and examine the impact of health IT in specific clinical settings and for specific health conditions, thus providing a cross-sectional view of health IT. The projects will be evaluated to identify both barriers and successful approaches to health IT implementation, and to determine providers' and patients' satisfaction with the outcomes.
AHRQ will also evaluate costs and benefits, and help determine the strength of the business case for investing in health IT. Finally, the Agency will focus on how health IT may change workflow for clinicians, and the challenges and opportunities of such changes.
How does AHRQ's health IT initiative fit into the overall national health IT effort?
The adoption of health IT throughout the nation's health care system is a high priority for President Bush, who in 2004 signed an executive order establishing an Office for the National Coordinator for Health Information Technology at the White House. AHRQ's initiative embraces and advances the goals and objectives of both Health and Human Services Secretary Michael O. Leavitt and National Coordinator for Health Information Technology David J. Brailer, M.D., Ph.D.
AHRQ's initiative provides support for health IT planning and implementation, especially in areas where health IT penetration is low. But beyond this financial support, the unique importance of AHRQ's initiative is its capacity to systematically observe real-world applications of health IT. AHRQ will evaluate the impact of these applications on providers, patients, and health outcomes - and share the findings of this real-world laboratory, as well as other tools and technical support, through the AHRQ National Resource Center for Health Information Technology.
If the full value of health IT is to be realized, it must be adopted throughout the health care system, and health IT in physician practices and hospitals is especially crucial. As a real-world laboratory, AHRQ's review of working health IT programs will provide insight that will help clinicians make health IT investment decisions, health IT developers refine and improve their products, and policymakers better understand health IT opportunities and challenges.
Imagine if every person in America had their personal health record (PHR) - with their medical histories and customized health education and guidance - available to them electronically. Such a breakthrough would dramatically increase consumers' participation in their own health maintenance and care - and possibly improve their satisfaction and even their outcomes.
Health IT is crucial for improving the quality, safety, and effectiveness of health care. When health IT elements are brought together in interconnected systems, clinicians will have access to information that is more timely and comprehensive than the current paper-based model can provide. The information will be specific to the patient being treated, and available at the point of care. This will result in better treatment decisions and fewer medical errors. Health IT will provide a new information foundation for health care that will be complete and up-to-date. Health IT also encourages active involvement by patients themselves, resulting in more patient-specific and patient-centered care.
Overall, adults in the U.S. receive only about 55 percent of recommended care for a variety of common conditions. Clinical decision support systems can help ensure that physicians and others have the most current information about the condition they are treating and are not overlooking important treatment options. These systems can provide treatment reminders at the point of care that apply to the specific patient being treated. In this way, evidence-based findings about best practices can be put into effect quickly. With health IT widely in place, researchers could also learn much more quickly about the effectiveness of new therapies, adding rapidly to the body of evidence-based medical knowledge.
An estimated 7,000 people die each year from medication errors alone. More than one in five Americans reported that they or a family member has experienced a medical or prescription drug error. One out of every 12 physician visits involving an elderly patient results in an improper medication prescription.
Yet, according to one estimate, more than 2 million adverse drug events and 190,000 hospitalizations per year could be prevented through e-prescribing, the ordering of prescriptions via computer (report by the Center for Information Technology Leadership: "The Value of Computerized Provider Order Entry in Ambulatory Settings").
E-prescribing can help physicians match the most effective therapy with the immediate needs of a specific patient, and do so at the best price for the patient. For example, when a physician enters a prescription for a patient, a computer program can double-check the medication, the dosage, and dangers from possible interactions with other drugs that the patient is taking, as well as possible allergic reactions.
Computer systems can also refer to the patient's health plan to determine drug coverage, so that the most cost-effective medication can be ordered.
Tens of thousands of Americans die in hospitals each year as a result of medical errors. In fact, medical errors are the eighth leading cause of death in this country. Health IT holds the potential to reduce medical errors dramatically by maintaining and sharing accurate patient health records, as well as providing clinicians with current information and reminders about medications, prevention, and follow-up care. Many of the projects in AHRQ's health IT initiative are testing new health IT applications with the specific purpose of improving patient safety. Similarly, a large number of research projects in AHRQ's patient safety portfolio focus on IT as a way to improve patient safety.
Health IT can improve health care quality substantially by providing timely access to health care information. Health IT systems improve the quality of care by avoiding duplication and medical errors, and they have the potential to reduce costs. Patients can be much more directly involved in maintaining their health and participating in decisions about their own care. Health care providers can collaborate more effectively in treating their patients.
In addition, health IT systems can be used to measure the care delivered in a health care facility or health plan, supporting efforts to measure and improve quality of care. Health IT-generated data can also be used to support "pay-for-performance" programs that reward providers for high-quality care. And, at the same time, information about the quality of care delivered by different providers could become more available, giving consumers more opportunity to make informed decisions about their health care, and further motivating providers to focus on quality.
Finally, health IT holds important public health implications: New technology can help to quickly identify disease outbreaks and provide data to support improvements in health care.
Why is it important for America to adopt health IT?
Good information is at the heart of good health care. This includes complete information about the patient, as well as reliable information about the best treatment options. This information should be available quickly and accurately, when and where it is needed. Unlike other business sectors, America's health care system has been slow to adopt information technology. We still rely primarily on paper-based models that impede effective information exchange. And because most Americans receive care from multiple health care providers, it is even more important to ensure efficient, coordinated, and secure exchange of information in all sectors of the health care system.
The potential value of health IT is well-known, yet relatively few providers so far have made significant investments in health IT. By the end of 2002, an estimated 13 percent of hospitals used electronic health records. Among physician practices, that estimate ranged from 14 to 28 percent. Small physician practices have been especially wary of investing in IT systems, fearing both the costs and workflow changes that could affect their practices.
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A computer-generated message generated when specific criteria are met; e.g., entry of a critically abnormal laboratory test value generates a warning message to the care provider who ordered the test.
The American Medical Association (AMA) is an organization of physicians which works on the most important professional and public health issues including health information technology (HIT).
The American Medical Informatics Association (AMIA) is an organization dedicated to the development and application of biomedical and health informatics in support of patient care, teaching, research, and health care administration.
Ambulatory medical record system (AMRS), which is a clinical information system that supports the functions of an outpatient clinic, generally including registration, appointment scheduling, order entry, reporting of results, clinical documentation, and billing.
The American Nurses Association (ANA) is a professional organization representing registered nurses with the goal of advancing the nursing profession by fostering high standards of nursing practice and lobbying Congress and regulatory agencies on health care issues affecting nurses and the public, including the use of information technology (IT) in nursing practice.
The American National Standards Institute (ANSI) oversees the creation, promulgation, and use and thousands of standards and guidelines, in nearly every sector of the economy, in order to strengthen the U.S. market in the world economy and to improve the health and safety of consumers.
A computer program designed to help physicians in the proper ordering of antibiotics.
The Arden Syntax standard, which is maintained by HL7, is a coding scheme which provides a standard means for writing rules designed to relate specific patient situations to appropriate actions.
Application Service Provider (ASP) is a type of client-server installation where a business hosts computer-based services for customers to access across a network, such as electronic health record (EHR) solutions accessed over the Internet.
A mode of communication in which exchange of data does not require both parties to be actively involved at the same time.
Asynchronous transfer mode (ATM) is a network protocol for sending small, fixed-length packets of data over network connections.
A record of all accesses and updates to medical data, which is generally maintained in chronological order, which is used to promoted accountability of access to the data.
A process for the positive identification of system users; this process is used to control access to the system.
A process for limiting user access and activities to only the actions deemed appropriate for that user.
The American Academy of Family Physicians (AAFP) is the national association of family doctors; its mission is to improve the health of patients, families, and communities which includes the introduction and use of health information technology (HIT).
A level of encoding of medical data which involves reviewing the data and labeling the data based on an item from a terminology.
A security function in which users are responsible for their access to and use of medical information. The users must have a right to know and a need to know the information they access.
Time between learning sessions when teams work on improvements within their organization. The teams are supported by collaborative faculty/staff.
An adverse drug event (ADE) is an unexpected or dangerous reaction to a drug.
Admission-discharge-transfer (ADT), which is a component of a health information system (HIS) designed to maintain and update the hospital census.
Computer software designed to operate with a degree of autonomy from its programmer (e.g., an agent may be used to search the Internet for specified information).
The American Hospital Association (AHA) is the national organization representing all types of hospitals, health care networks, and their patients plus communities. It strives to ensure that its members’ perspectives and needs are addressed in national health policy development, legislative and regulatory debates, and judicial matters; this includes issues related to health information technology (HIT).
The American Health Information Community (AHIC) is a federal government advisory body chartered to provide recommendations to the Secretary of the U.S. Department of Health and Human Services (HHS) on how to accelerate the development and adoption of health information technology (HIT).
The American Health Information Management Association (AHIMA) is a professional organization devoted to improving healthcare by advancing best practices and standards for health information management (HIM).
Agency for Healthcare Research and Quality (AHRQ) is the lead federal government agency charged with improving the quality, safety, efficiency, and effectiveness of health care for all Americans. As one of 12 agencies within the Department of Health and Human Services (HHS), AHRQ supports health services research that will improve the quality of health care and promote evidence-based decision making.
This refers to the amount of data that can be transmitted over a communication channel in a given period of time.
A measurement obtained prior to an intervention and used for comparison to post-intervention measurements.
The College of American Pathologists (CAP) is a professional organization of pathologists which fosters and advocates excellence in the practice of pathology and laboratory medicine. It was responsible for developing the Systematized Nomenclature of Medicine (SNOMED).
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